14 Baker Ave Please complete the form below: Name * First Name Last Name Current Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * Email * Primary Phone * (###) ### #### Drivers License State & Number Is your current address owned or rented? If owned, please provide mortgage company * If rented, please provide current Landlord's name and phone number If rented, what was your monthly payment Please list all persons who will occupy the house with you Are you currently employed? Employer Name Job Title Monthly Gross Income Vehicles Pets Do you have any charge pending against you for criminal offenses? Are you party to any civil law suit filed against you? Have you ever filed bankruptcy? If you answered yes to any of the above questions, please provide details, including dates, locations, and a brief explanation I represent that all of the above information is true and complete. I understand that, if any of the above information is false or incomplete, the Landlord ("Landlord"), upon learning the untrue or incomplete information, will have the right to deny this Application, terminate my right to occupy the House and/or retain all deposits and fees that I have paid up to that time. I authorize Landlord to obtain consumer reports, which may include a credit check, rental payment history report, and criminal background check. I authorize Landlord to perform follow-up reports during the period of my tenancy for any purpose permitted by law. I understand that Landlord may report my rental payment status and history to consumer reporting agencies. I hereby release Landlord from all liability for supplying that information -- Landlord does not discriminate on the basis of age, race, color, religion, national origin, ancestry, gender, sexual orientation, marital status, physical or mental disability or lawful source of income -- The terms of the lease will control in the event of any inconsistency between this Application and the terms of the lease. * Signature * Date Signed * MM DD YYYY Thank you for applying to join the Gault family!
